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Traumatic Rhabdomyolysis


Presentation

  • Abstract The case is presented of a 34-year-old woman with rhabdomyolysis due to massive intake of nimetazepam, a benzodiazepine hypnotic. On admission, the patient had numerous blisters all over the body.[ncbi.nlm.nih.gov]
  • Abstract A clinical profile of non-traumatic rhabdomyolysis with acute renal failure is presented. Myoglobinuric renal failure is treatable and hence a high index of suspicion is warranted in the etiologies discussed.[ncbi.nlm.nih.gov]
  • Twelve patients presented with muscular pain and seven patients with muscle weakness. Twenty eight patients had urinalysis and five of them (18%) had negative orthotolidine dipstick test.[ncbi.nlm.nih.gov]
  • Profound hyperuricemia was present in most patients. Transient hypercalcemia developed during the diuretic phase in 5 patients. One patient died.[annals.org]
  • We will present and discuss in this article the pathophysiological and clinical features of non-traumatic rhabdomyolysis, focusing specifically on Emergency Department (ED) management. Copyright 2017 The Canadian Society of Clinical Chemists.[ncbi.nlm.nih.gov]
Hemophilia A
  • Stay up to date with new chapters on Clotting Disorders and Hemophilia, Patient-Centered Care, Health Disparities and Diversity in Emergency Medicine, Cost-Effectiveness Analysis, Antibiotic Recommendations for Empirical Treatment of Selected Infectious[books.google.com]
Aspiration
  • Initiation of Parenteral Nutrition 248 Classification of Enteral Formulas 252 Selection of Formula for Enteral Nutrition 255 Planning an Enteral Feed 260 Modification of the Formulation in Different Clinical Situations 269 Methods to Decrease Risk of Aspiration[books.google.com]
Blister
  • On admission, the patient had numerous blisters all over the body. One of the blisters in the gluteal region developed into a deep ulcer accompanied by muscle necrosis although it was not at a pressure point. The ulcer needed surgical intervention.[ncbi.nlm.nih.gov]
Myopathy
  • […] query for traumatic rhabdo in which they reference 3 types of rhabdo: -Traumatic or muscle compression (eg, crush syndrome or prolonged immobilization) -Nontraumatic exertional (eg, marked exertion in untrained individuals, hyperthermia, or metabolic myopathies[forums.acdis.org]
  • It can be induced by numerous factors, including a crush injury to a limb, overuse of skeletal muscle, heat, alcoholism, viral infections, metabolic disorders, myopathies, drugs, toxins, and hypokalemia.[nejm.org]
  • .- ) muscular dystrophies and myopathies ( G71 - G72 ) myopathy in amyloidosis ( E85.- ) myopathy in polyarteritis nodosa ( M30.0 ) myopathy in rheumatoid arthritis ( M05.32 ) myopathy in scleroderma ( M34.- ) myopathy in Sjögren's syndrome ( M35.03 )[icd10data.com]
  • Longer-term myalgias may be indicative of a metabolic myopathy, some nutritional deficiencies or chronic fatigue syndrome.[dbpedia.org]
  • Less common inherited causes of rhabdomyolysis include structural myopathies, channelopathies, and sickle-cell disease.[pubfacts.com]
Muscle Swelling
  • Lethargy or coma was present in 17 patients and muscle swelling in 11. Evidence of rhabdomyolysis included markedly elevated creatine phosphokinase, myoglobinuria, and aldolase in blood.[annals.org]
  • Crush injury is compression of extremities or other parts of the body that causes muscle swelling and/or neurological disturbances in the affected areas of the body, while crush syndrome is localized crush injury with systemic manifestations. [1] Cases[en.wikipedia.org]
  • Crush Injury: Compression of extremities or other parts of the body that causes muscle swelling and/or neurological disturbances. Crush Syndrome: Crush injury with systemic manifestations.[clinicaladvisor.com]
Convulsions
  • The primary conditions which led to rhabdomyolysis and acute renal failure were burns, eclampsia, prolonged labour, crush injury, epileptiform convulsions, status asthmaticus, viral myositis and intoxication with chemicals including copper sulphate, mercuric[pmj.bmj.com]

Treatment

  • Preventing the systemic and renal complications of the crush syndrome requires very early and vigorous treatment to sustain the circulation, preferably started at the site of the catastrophe.[ncbi.nlm.nih.gov]
  • Get clear, concise descriptions and evidence-based treatment guidelines for a full range of clinical conditions, ranging from the common to the unusual.[books.google.com]
  • Bicarbonate and mannitol treatment for traumatic rhabdomyolysis revisited. American Journal of Surgery, 213 (1), 73-79.[ohsu.pure.elsevier.com]
  • Crush syndrome sustained in the 1995 Kobe, Japan, earthquake; treatment and outcome. Ann Emerg Med 1997;30(4):507-12. Sever MS, Erek E, Vanholder R, Ozener C, Yavuz M, Kayacan SM, et al.[acta.tums.ac.ir]

Prognosis

  • The disease has good prognosis despite severe hypercatabolism and untreated profound hyperuricemia. FULL TEXT[annals.org]
  • OBJECTIVES: We assessed identification and management of these patients, considering: (i) early adverse parameters used to identify poor prognosis, (ii) the importance of early recognition, and (iii) appropriate management with aggressive fluid therapy[ncbi.nlm.nih.gov]
  • The vital prognosis of post-traumatic crush injury was good but the sequelae of the compartment syndrome were major. The need for RRT was not linked to CPK levels but rather to acidosis due to intra-abdominal complications.[ccforum.biomedcentral.com]
  • DOI: 10.1007/BF00200505 Rhabdomyolysis with myoglobinuria and acute renal failure can develop from a variety of traumatic and nontraumatic reasons and the clinical as well as forensic significance of it may vary from an epiphenomenon with an excellent prognosis[semanticscholar.org]
  • The prognosis for recovery will depend on the amount of kidney damage, which often depend on how early the symptoms were identified. Those with mild cases should be able to resume normal activity within a few weeks to a month.[healthguidance.org]

Etiology

  • Myoglobinuric renal failure is treatable and hence a high index of suspicion is warranted in the etiologies discussed.[ncbi.nlm.nih.gov]
  • Drug abuse, seizure, and excessive activity are the most common etiologies for non-traumatic rhabdomyolysis. Twelve patients presented with muscular pain and seven patients with muscle weakness.[ncbi.nlm.nih.gov]
  • The most common causes are muscle overextension, muscle compression and crush injury, but there are also numerous non-traumatic etiologies. The latter group can be broadly divided into toxic, infectious and metabolic causes.[news-medical.net]
  • […] synonyms: Rhabdomyolysis ICD-10 M62.82 - Rhabdomyolysis Rhabdomyolysis ICD-9 728.88 Rhabdomyolysis 728.88 Etiology / Epidemiology / Natural History muscle necrosis causing the release of myoglobin into the bloodstream.[eorif.com]
  • The final common pathway in the cellular pathophysiology of rhabdomyolysis, regardless of etiology, is believed to be an impairment of either production or utilization of adenosine triphosphate (ATP).[ahcmedia.com]

Epidemiology

  • Angus' research, funded principally by the NIH, focuses on clinical, epidemiologic and translational studies of sepsis, pneumonia, and multisystem organ failure and on health services research of the organization and delivery of critical care services[books.google.com]
  • […] synonyms: Rhabdomyolysis ICD-10 M62.82 - Rhabdomyolysis Rhabdomyolysis ICD-9 728.88 Rhabdomyolysis 728.88 Etiology / Epidemiology / Natural History muscle necrosis causing the release of myoglobin into the bloodstream.[eorif.com]
  • Prognostic and epidemiologic study, level III. Supplemental digital content is available in the text.[journals.lww.com]
  • Detailed descriptions of epidemiology of the renal patients and offered help have been provided previously [ 8 , 9 ].[ndt.oxfordjournals.org]
  • Epidemiology Rhabdomyolysis occurs in up to 85% of patients with traumatic injuries. 10–50% of patients with rhabdomyolysis develop ARF. Patients with rhabdomyolysis-induced renal failure have a mortality of approximately 20%.[clinicaladvisor.com]
Sex distribution
Age distribution

Pathophysiology

  • We will present and discuss in this article the pathophysiological and clinical features of non-traumatic rhabdomyolysis, focusing specifically on Emergency Department (ED) management. Copyright 2017 The Canadian Society of Clinical Chemists.[ncbi.nlm.nih.gov]
  • Cirrhosis Controversial Indications Transfer to Specialized Centers Introduction Conclusion Alterations in Brain Metabolism and Use of Barbiturates Hypothermia Cerebral Perfusion Pressure and Neurointensive Care Treatment of PostTraumatic Brain Edema Pathophysiologic[books.google.com]
  • The pathophysiology of crush injury is not fully understood and no good animal model is known. Crush syndrome, which is the general manifestation of crush injury, is better understood. If not prevented, it will lead to acute renal failure.[ncbi.nlm.nih.gov]
  • Llach F, Felsenfeld AJ, Haussler MR: The pathophysiology of altered calcium metabolism in rhabdomyolysis-induced acute renal failure: Interactions of parathyroid hormone, 25-hydroxycholecalciferol, and 1,25-dihydroxycholecalciferol.[karger.com]
  • Pathophysiology The pathophysiology begins with muscle injury and muscle cell death. Immediate cell disruption. Direct pressure on muscle cells: The direct pressure causes muscle cells to become ischemic.[clinicaladvisor.com]

Prevention

  • Preventing the systemic and renal complications of the crush syndrome requires very early and vigorous treatment to sustain the circulation, preferably started at the site of the catastrophe.[ncbi.nlm.nih.gov]
  • See: reperfusion Patient care The goals of treatment are to prevent and treat renal dysfunction, reverse electrolyte abnormalities, and correct the underlying cause.[medical-dictionary.thefreedictionary.com]
  • It also prevents neutrophil adhesion and prevents secondary injury. It is directly bactericidal to anaerobic organisms.[clinicaladvisor.com]
  • Background A rhabdomyolysis protocol (RP) with mannitol and bicarbonate to prevent acute renal dysfunction (ARD, creatinine 2.0 mg/dL) remains controversial.[ohsu.pure.elsevier.com]

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